Case of Aortic Dissection Diagnosed by Suprasternal Notch Point-of-Care Ultrasound (POCUS) in a 73-Year-Old Man With Chest and Lower Extremity Pain

Early detection of aortic dissection is critical, as it can be quite elusive. Suprasternal notch (SSN) point-of-care ultrasound (POCUS) is underutilized in emergency department settings. A 73-year-old man with hypertension, hyperlipidemia, smoking history, and a known aortic aneurysm presented with two hours of severe left-sided chest pain, left leg pain, numbness, and weakness. Physical examination revealed an irregular, slow pulse and a non-palpable left posterior tibial pulse. The electrocardiogram showed atrial fibrillation with slow ventricular response. POCUS parasternal view revealed a dilated aortic root; SSN view, performed by an intern, clearly demonstrated an intimal flap. Computed tomography angiography (CTA) confirmed Stanford Type A dissection extending to the renal arteries and occluding the left common iliac artery. Emergent cardiothoracic and vascular surgery consultation and transfer for definitive operative management were initiated before CTA results. This case highlights the diagnostic utility of SSN POCUS, especially in novice hands, for rapid identification of life-threatening aortic pathology.